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Form W-9 (Rev, .10-2018)
<br />Pase 5
<br />L lnterest, dividend, and barter exchange accounts opened
<br />before 1984 and broker accounts considered active during 1993.
<br />You must give your correct TlN, but you do nol have to sign the
<br />certification.
<br />2. lnterest, dividend, broker, and barter erchange accounts
<br />opened afteillg8il and broker accounts considetod inaetive during
<br />1983. You must sign the certification or backup withholding will apply. lt
<br />you ar€ subject to backup withholding and you are merely providing
<br />your correct TIN to the requester, you must cross out item 2 in the
<br />certification before signing the form.
<br />3. Real estate transactions. You must sign the certification. you may
<br />cross out item 2 of the cedification.
<br />4. Other payments. You must give your correct TlN, but you do not
<br />have to sign the certiiication unless you have been notified that you
<br />have prevaously given an incorrect TlN. ,,Other payments" include
<br />payments made in the course of the requester,s trade or business for
<br />rents, royalties, goods (other than bills for merchandise), medical and
<br />heallh care services (including payments to corporations), payments to
<br />a nonemployee for services, payments made jn settlement of payment
<br />card and third party network transactions, payments to certain filhing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (including payments io corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonm€nt of
<br />secured property, cancellation of debt, qualitiEd luition program
<br />paymenls (under section 529), ABLE accounts (under section 529A),
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. you must give your correct
<br />TlN, but you do not have to sign the certiiication.
<br />For this type of account:GivE name and EIN of:
<br />What Name and Number To Give the Requester
<br />For this Upe of account:Give name and SSN of:
<br />with the Dopartment
<br />Agriculture ]n the name o{ a public
<br />entity (such as a state or local
<br />gov6rnment, school district, or
<br />prison) that receives agricultural
<br />program payments
<br />1 5. Grantor trust filing under the Form
<br />'104'l Filing lvlethod or lhe Optional
<br />Form 1099 Filing Mothod 2 (see
<br />Regulations section 1.6/l "4(bx?)t4(gl
<br />The trust
<br />1 List first and circle the name of the person whose number you furnish.
<br />lf only one person on a joint account has an SSN, that pers6n's number
<br />must be furnished.
<br />2 Crrcle the minor's name and furnish the minor's SSN.
<br />3 You must s!:ory your individual nane and you may also enter your
<br />business or DBA name on the "Business name/dlsregarded entity"
<br />name line. You may use either your SSN or EIN (if you have one), but the
<br />IRS encourages you to use your SSN.
<br />4 List first and circle the name of the trust, estate, or pension trust. (Do
<br />not furnish the TIN of the personal representative or trustee unless ihe
<br />legal entity itself is not designated in the account title.) Also see Speca/
<br />rules for partnershlps, earlier.
<br />*Note: The grantor also must provide a Form W-9 to trustee of trust.
<br />Note: lf no name is circled when more lhan one name is listed, the
<br />number will be considered to be that of the first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs when someone uses your personal information
<br />such as your name, SSN, or other identifying information, without your
<br />permission, to commit fraud or other crimes. An identity thief may use
<br />your SSN to get a job or may file a tax return using your SSN to receive
<br />a refund,
<br />To reduce your risk:
<br />r Protect your SSN,
<br />. Ensure your employer is protecting your SSN, and
<br />. Be careful when choosing a tax preparer.
<br />lf your tax records are affected by identity theft and you receive a
<br />notice from the lRS, respond right away to the name and phone number
<br />printed on the lFlS notice or letter.
<br />lf your tax records are not currenlly affected by identity theft but you
<br />think you are at risk due to a lost or stolen purse or wallet, qu€stionable
<br />credit card activity or credit report, contact the IRS ldentity Theft Hotline
<br />at 1 -800-908-4490 or submit Form 1 4039.
<br />For more information, see Pub. 5027, ldentity Theft lnformation for
<br />Taxpayers.
<br />Victims of identity theft who are experiencing economic harm or a
<br />systemic problem, or are seeking help in resolving tax problems thai
<br />have not been resolved through normal channels, may be eligible for
<br />Taxpayor Advocate Service [AS) assistance. You can reach TAS by
<br />calling lhe TAS toll-free case intake line at 1-BlT-777-471A or tryfiDO
<br />1 -800-829-4059.
<br />Protect yourself lrom suspicious emails or phishing schemes.
<br />Phishing is the creation and use of email and websites designed to
<br />mimic legitimate business emails and websites. The most common act
<br />is sending an email to a user falsely claiming to be an established
<br />legitimate enterptise in an attempt to scam the user into surrendering
<br />private information that will be used for identity theft.
<br />14.
<br />1. lndividual
<br />2. Two or more individuals {joint
<br />accountl other than an account
<br />maintained by an FFI
<br />3. Two or more U.S, persons
<br />{joint account mainlained by an FFI)
<br />4. Custodial account of a minor
<br />(Uniform Gilt to Minors Act)
<br />5. a. Tho usual rsvocable savings trust
<br />{grantor is also trustee)
<br />b, So-called trust account that is not
<br />a legal or valid trust under state law
<br />6. Sole proprietorship or disregarded
<br />entity owned by an individual
<br />7. Grantor trust liling under Optional
<br />Forn 1099 Filirg \4ethod 1 (see
<br />Regulations sect,on 1 .671-4{bX2Xi}
<br />For this type of account:
<br />8. Disregarded entity owned by an
<br />individual
<br />L A valjd lrust, eslate. or p€nsion trusl
<br />1 0. Corporation or LLC electing
<br />corporate status on Form 8832 or
<br />Form 2553
<br />'1 1. Association, club, religious,
<br />chariiable, educational, or other lax-
<br />exempt organization
<br />'12, Parlnership or multi-member LLC
<br />13. A broker or registered nominee
<br />The individual
<br />The aclual owner of the account or, il
<br />combined lunds, lhe iirst;ndividual on
<br />the accountl
<br />Each holdsr of the account
<br />:Ine mtnot
<br />The grantor-trusteel
<br />The actual ownerl
<br />The owne13
<br />The grantor'
<br />Give name and EIN of:
<br />The owner
<br />Legal entitya
<br />The corpotalion
<br />The organizalion
<br />ThE partnership
<br />The broker or nominee
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